Rethinking Clinical Governance: Healthcare Professionals Views A Delphi study Gepke L. Veenstra University Medical Centre Groningen, Centre of Expertise on Quality and Safety, the Netherlands Kees Ahaus University Medical Centre Groningen, Centre of Expertise on Quality and Safety University of Groningen, Faculty of Economics and Business, Department Operations, the Netherlands EHMA Conference Porto 2016 12
In collaboration with E. Heineman University Medical Centre Groningen, Department of Surgery, Groningen, the Netherlands; University Medical Centre Groningen, Department of Surgery, Groningen, the Netherlands. G. A. Welker University Medical Centre Groningen, Centre of Expertise on Quality and Safety, Groningen, the Netherlands. M. J. van der Laan University Medical Centre Groningen, Department of Surgery, Groningen, the Netherlands. F. L. H. Muntinghe University Medical Centre Groningen, Department of Internal Medicine, Groningen, the Netherlands. 13
Overview Introduction Clinical governance Aim & Approach Methods Results Conclusion Q & A 14 Overview Introduction Methods Results Conclusion Q & A
Introduction We always hope for the easy fix: the one simple change that will erase a problem... But few things in life work this way. Instead, success requires making a hundred small steps go right one after the other, no slipups, no goofs, everyone pitching in. 1 1. Gawande, Atul. Better: A surgeon's notes on performance. Profile, 2007. 15 Overview Introduction Methods Results Conclusion Q & A
Introduction Clinical governance: continuous improvement of quality of healthcare by all individuals that are involved in a patient s care 2 2. Secretary of State for Health. The New NHS: Modern, Dependable 1997. 16 Overview Introduction Methods Results Conclusion Q & A
Introduction Health care is provided to patients by healthcare professionals who work in complex organisational arrangements The overwhelming amount of their daily work is part of clinical microsystems Clinical Microsystems The place where patients and healthcare professionals meet A framework for quality improvement The workfloor! 17 Overview Introduction Methods Results Conclusion Q & A
Introduction Dominant logic strong signal Complexity I II Organisational development weak signal Development through time I = change within the existing context II = change by altering context 18 Overview Introduction Methods Results Conclusion Q & A
Introduction Ultimately, the secret of quality is love. You have to love your patient, you have to love your profession, you have to love your God. If you have love, you can then work backward to monitor and improve the system Avedis Donabedian 3 3. Mullan F. A founder of quality assessment encounters a troubled system firsthand. Health Affairs. 2001;20(1):137-141. 19 Overview Introduction Methods Results Conclusion Q & A
Clinical Governance 4 Ownership Communication Patient- Professional Relationship Leadership Systems Awareness Teamwork 4. Nicholls S, Cullen R, O'Neill S, et al. Clinical governance: its origins and its foundations. Br J Clin Gov 2000;5:172-8. 20 Overview Introduction Methods Results Conclusion Q & A
Aim & Approach Aim Explore degree of agreement between literature and healthcare professionals views Approach Combination of literature study and Delphi study 21 Overview Introduction Methods Results Conclusion Q & A
Literature study List of elements 99 elements Derived from articles E.g. Clinical governance leads to an open culture 22 Overview Introduction Methods Results Conclusion Q & A
Delphi method 5,6 Delphi study Expert opinions Consensus Multistage, interactive process Panel of experts Healthcare professionals from UMCG (N = 24) 9 nurses, 15 medical specialists 50% female, M age = 42.17, SD = 7.41; M tenure = 11.42, SD = 5.94 5.Iqbal S, Pipon-Young L. The Delphi method. Psychologist 2009;22:598-600. 6.Linstone HA, Turoff M. The Delphi Method. Techniques and applications 2002;53. 23 Overview Introduction Methods Results Conclusion Q & A
Delphi study List of elements Responses 4 point scale (1 = not important to 4 = very important) Criteria for consensus: perceived importance ( 3) 7 included: 80% reassessed: 51-80% excluded: 50% 7. Minkman M, Ahaus K, Fabbricotti I, et al. A quality management model for integrated care: results of a Delphi and Concept Mapping study. International Journal for Quality in Health Care 2009;21:66-75. 24 Overview Introduction Methods Results Conclusion Q & A
Go to www.govote.at and enter the code 22 41 55 to vote Vote with your mobile or any other device 25 Overview Introduction Methods Results Conclusion Q & A
Statement 1: It is important for clinical governance that patients are encouraged to engage in decisions about their care https://www.mentimeter.com/a pp/edit/a907bbcce555b42ebd 44b49c33500dc0/5e25f93f496 8 26 Overview Introduction Methods Results Conclusion Q & A
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Results Table 1 Delphi panel results Round 1 Round 2 Round 3 Response (N = 24) 95.83% 100% 100% Elements (numbers) 99 47 32 Included 39 10 1 Excluded 19 5 13 Rephrased 19 8 0 Unchanged 22 24 0 New elements 6 0 0 28 Overview Introduction Methods Results Conclusion Q & A
General Elements Included Clinical governance shows that leadership, collaboration and communication are as important for high quality health care as risk management and clinical effectiveness Quote: Quality improvement and risk management are a logical consequence of the existing culture, rather than a strategy in itself Excluded Clinical governance is used to monitor poor performance 29 Overview Introduction Methods Results Conclusion Q & A
Ownership Included Clinical governance assigns a central role to healthcare professionals Excluded Clinical governance makes each manager feel responsible for the safeguarding of quality 30 Overview Introduction Methods Results Conclusion Q & A
Teamwork Included Clinical governance changes the culture by focusing on collaboration between various specializations Quote: Teamwork is a central element of clinical governance Excluded Clinical governance is a system that moves beyond current methods of quality improvement and emphasizes learning from each other 31 Overview Introduction Methods Results Conclusion Q & A
Leadership Included Clinical governance leads to effective leaders who have a clear understanding of the reality and inspire other healthcare professionals to develop a collective vision Excluded Clinical governance is designed to be a top-down and professionally lead initiative 32 Overview Introduction Methods Results Conclusion Q & A
Communication Included Clinical governance aims at creating an open and participative environment with teamwork, excellent communication and aligned goals Excluded Clinical governance makes that the healthcare professional is listened to 33 Overview Introduction Methods Results Conclusion Q & A
Systems Awareness Included Clinical governance contributes to a learning organization in which safe and efficient systems are valued and mistakes are perceived as learning opportunities Excluded Clinical governance contributes to effective risk management by standardizing clinical practices Quote: The clinical practice is difficult to standardize 34 Overview Introduction Methods Results Conclusion Q & A
Patient Involvement Included Clinical governance ideally leads to better attuning of all involved healthcare professionals and the patient Excluded Clinical governance encourages patients to engage in decisions about their care 35 Overview Introduction Methods Results Conclusion Q & A
Conclusion: clinical governance 2.0 Clinical governance is a practice-based, bottom-up, and value-driven approach does not entail an overly emphasis on managerial approaches is underpinned by teamwork and continuous learning entails shared responsibility and good relationships between healthcare professionals, managers and patients 36 Overview Introduction Methods Results Conclusion Q & A
Thank you for your attention c.t.b.ahaus@rug.nl g.l.veenstra@umcg.nl 37 Overview Introduction Methods Results Conclusion Q & A